Chronic prostatitis is pelvic or perineal pain without evidence of urinary tract infection lasting longer than three months. The National Institutes of Health (NIH) classifies prostatitis into four syndromes. This article discusses the four prostatitis syndromes listed in the medical research and by the NIH.
Prostatitis affects half of all men
Prostatitis is a common condition affecting almost half of all men during their lifetimes. Prostatitis accounts for over two million outpatient visits every year. One percent of all primary care visits in the United States is for prostatitis.
Prostatitis – the “wastebasket of clinical ignorance”
Prostatitis has been called the “wastebasket of clinical ignorance.”
Stamey, Thomas Alexander, 1989, “Pathogenesis and Treatment of Urinary Tract Infections,” Lippincott, Williams and Wilkins
Historical confusion – the many names of Prostatitis
Prostatitis is referred to by several different names, some are proper and some describe slightly different conditions such as:
levator ani syndrome,
unspecified anorectal pain,
bladder pain syndrome,
chronic pelvic pain syndrome,
Physicians tend to manage patients with prostatitis based on a patchwork of what they learned during residency, experience, the last paper on the subject they read, and perhaps a touch of evidence.
Chronic pelvic pain (CPP) occurs in women and men. The American College of Obstetricians and Gynecologists’ (ACOG) definition applies to women. The European Association of Urologists (EAU) revised their guidelines beginning in 2009 to include women and men in their definition of chronic pelvic pain. Chronic pelvic pain is a bladder pain syndrome that occurs in women and men. Urological pain syndromes in men include Chronic Prostatitis / Chronic Pelvic Pain Syndrome (CPPS).
Chronic pelvic pain has two different definitions:
Historically, chronic pelvic pain (CPP), was defined by the American College of Obstetricians and Gynecologists (ACOG) and applied to women.
In 2009, the European Association of Urology (EAU) published EAU Guidelines on Chronic Pelvic Pain. Their stated objective was “to revise guidelines for the diagnosis, therapy, and follow-up of CPP patients.”
The European Association of Urologists (EAU) guidelines distinguish between gynecological, gastrointestinal and musculoskeletal pain syndromes in women and men.
In the revised guidelines published by the European Association of Urology (EAU) on Chronic Pelvic Pain, they included chapters on chronic prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynecologic practice and others.
ACOG’s Definition of Chronic Pelvic Pain (CPP)
The American College of Obstetricians and Gynecologists (ACOG) definition of chronic pelvic pain.
“Pain lasting for six or more months that localizes to the anatomic pelvis, anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks and is of sufficient severity to cause functional disability or lead to medical care. Chronic pain can come and go or it can be constant.” (1)
American College of Obstetricians and Gynecologists, 2011
Chronic Pelvic Pain Continues after a Hysterectomy
“Approximately 12 percent of hysterectomies are performed for pelvic pain and 30 percent of patients who seek treatment at pain clinics have already had a hysterectomy.” (2)
Novak’s Textbook of Gynecology, 12th Ed, 1996
EAU’s Definition of Chronic Pelvic Pain (CPP)
The European Association of Urology (EAU) includes both women and men in its definition of chronic pelvic pain and defines chronic pelvic pain as follows (Ref. 2013):
“Chronic or persistent pain perceived in structures related to the pelvis of either men or women. The pain must be continuous or recurrent for at least six months.” (3)
European Association of Urology, 2013
Urological Pain Syndromes-Women / Men
When the pain is localized to a single organ, some specialists may wish to consider using an end organ term such as “Bladder Pain Syndrome.” Urological pain syndromes include bladder pain syndrome, which is often termed as interstitial cystitis.
Urological Pain Syndromes in Men
Urological pain syndromes in men include Prostate Pain Syndrome, which is often termed Chronic Prostatitis / Chronic Pelvic Pain Syndrome according to the National Institute of Health (NIH) classification of chronic prostatitis.
Dyspareunia is defined as genital pain that occurs before, during or after intercourse. This is a common sexual problem. Dyspareunia can occur in women and men. Some sources estimate dyspareunia occurs in two-thirds of all women. The medical literature does not quantify the number of men with this condition. Vaginal infections or infections of the prostate are the most common successfully-treated causes of dyspareunia.
Dyspareunia – Painful Sex in Women & Men
What is Dyspareunia?
Dyspareunia can be defined as difficult mating. It is not a well understood condition. This problem can be lifelong or acquired. Dyspareunia usually occurs ten years after the start of sexual activity unless it has always been present. Causes can be an infection, a skin problem, trauma, dryness, male factors, such as prostatitis as well as other physical and psychological factors.
“I hold it true, whate’er befall;
I feel it when I sorrow most;
Tis better to have loved and lost
Than never to have loved at all.”
Alfred Lord Tennyson
“Dyspareunia (difficult mating) is defined as genital pain that occurs before, during, or after intercourse. The repeated experience of pain during intercourse can cause marked distress, anxiety, and interpersonal difficulties, leading to anticipation of a negative sexual experience and eventually to sexual avoidance.”